About

Conquer Your Chronic Pain
“We eventually discovered that the patients who took the least amount of medicine, or none at all, did better, improved their functioning in daily life more, and were more likely to return to work than those who took the strongest pain killers…”

At a time when opiate use is being questioned as a symptom management tool for chronic pain, Dr. Abaci opens his new book with the challenging (exciting) thought that medications of any sort are not the key to living successfully with chronic pain.

Dr. Peter Abaci is a certified anesthesia and pain management specialist and author who serves as the Medical Director and cofounder (with Dr. John Massey) of the Bay Area Pain and Wellness Center in Los Gatos, California. As important as his professional credentials is his patient cred – Dr. Abaci lives with chronic pain as the result of a serious knee injury. His search to find effective treatment for himself led to the application of the biopsychosocial approach to pain management which encompasses a holistic view of the causes and consequences of chronic pain and provides practical means for improving quality of life for those living with chronic pain.

Conquer Your Chronic Pain explores what works, and what doesn’t in an easy-to-read conversational style that will inspire you to rethink your pain management strategies. Each chapter informs you about a key aspect of managing chronic pain: from the physiological changes that keep your brain stuck in a pain-perceiving mode to the elements of personality and thinking that reinforce pain to the social and political issues that foster reliance on partly effective treatment approaches. His three “R’s” plan of Restoration, Recovery and Relief addresses the key obstacles to pain reduction in ways that could free you from dependence on medications. If you are ready to be empowered and take charge of your pain, this book will show you where and how to make the changes that will benefit you most.

The Practicality of the Bright Side

Bright SideYou’ve heard the saying “I’ll believe it when I see it”.  What’s more accurate is that you’ll see it when you believe it.  Perception and perspective make all the difference in how you experience life.  Choosing your perspective is a key practice for cultivating resilience.

Every day, I try to publish at least one thought on Twitter that encourages people to use positive thinking to manage their chronic pain.  To some, that may come across as “goody-goody”, “unrealistic” nonsense.  Let me explain why it’s not.

Western society has adopted the notion that the mind and body are separate.  While that can be a useful idea when you are trying to understand someone’s health or behaviour, it is not literally true.  What happens with your body affects your mind and vice versa. What’s more, science has demonstrated this to be true and research is guiding the development of treatments to make better use of this feature.

Fibromyalgia, for example, is known to worsen with stress, and stress may even play a causal role in its development.  One way of managing stress involves noticing negative thoughts and reframing them in more positive, often more realistic, ways.  This is the basic process of Cognitive Behaviour Therapy.

How do you choose perspective?  One way to do it is to be mindful about the words you use to express your thoughts and to challenge words that indicate an extreme. For example, let’s say you had a tense interaction with your boss.  You might think:

“What a catastrophe that was!  It was horrible!  If I didn’t screw up so much, my boss wouldn’t chew me out like that…”

Challenging that thought, you might think:

“Was it really a catastrophe?  I didn’t get fired, I just got told to do better.  Maybe it wasn’t THAT horrible.  I’ve come through worse situations.”

Reframing it, you might think:

“My boss was critiquing my performance to help me see where I need to improve.  While I don’t feel great about that, I understand I have some things to learn and I now know what my next steps will be.  I’ll do much better next time.”

The more you can make this process habitual, the more positive your thoughts become, the lower your stress will be and this may result in lower pain levels, depending on the nature of your condition(s).  Just look on the bright side to give it a try.

Complicated Communication: Talking About Pain

If you live with chronic pain, you may relate to the message conveyed by this image. I know I do.

The experience of having the severity of your pain doubted is not unique to people with chronic pain; it happens to people experiencing acute pain too.  For example, people with acute back pain may be suspected of malingering and have to undergo tests to reproduce or aggravate their symptoms to prove they are not faking it.

Why does this happen?  Some guesses:

  • pain seems more suspect when there is no observable injury or illness
  • pain may seem questionable when the people experiencing it also have periods where their pain is less or absent
  • pain becomes dismissible when the cause of it, or its qualities, lie outside of the experience of others; they haven’t had it so they don’t “get” it
  • the way the person in pain expresses their experience may not trigger empathy in others

Communicating about pain is complicated.  

There are cultural norms that may define how those in pain are expected to express it – the “stiff upper lip” would be one example, dramatic screaming and writhing would be another.

If your personal way of communicating about your pain does not match the cultural norm, what you express may fail to invoke empathy, nevermind sympathy, in others.  To them, you don’t appear to be in pain and non-verbal behaviours are always taken more seriously than what is said.

Some people who live with chronic pain will become less expressive about it over time as part of their adaptation process.  Some people will maintain their level and style of expressiveness, and come to be viewed (and dismissed) by others as constant complainers.  We know which of those groups most closely resembles us, but may not know how to compensate for it, so that those closest to us will believe us when we’re having high pain days.

There is no one-size-fits-all solution to this dilemma, but here are a few suggestions:

  • have a discussion about pain with your loved ones on a low-pain day
  • tell them you sometimes wonder if they believe how much pain you are in
  • ask them what is triggering their doubt
  • ask them what they would need to see/hear to change that
  • if you have an emotional reaction to what they’re saying, share how you are feeling without blaming them
  • consider having special words/phrases to use when your pain is at its worst such as “It’s a ‘5 alarm fire’ day” or “It’s a ‘DEFCON 1’ day”

The onus is on us to communicate about our pain in a way that is clear and understandable to others.  Talking about pain with loved ones can be difficult because it is likely to bring up sensitive subjects, but the value of feeling understood when you are at your worst is beyond measure.  Find your courage, have “the talk” – it will be worth it.

Fibromyalgia Reality Check

Fibro Reality CheckI’m quite active with the fibromyalgia community on Twitter.  On a regular basis, I see posts proclaiming “Fibromyalgia is real!” or something to that effect.

I understand where the need to proclaim the validity of this illness comes from.  Many people go through an arduous process on their way to a fibromyalgia diagnosis.  No one seems to believe how much pain they are in; no one can tell them why they are in pain.

When all the other possibilities have been eliminated, they are told they have fibromyalgia, an incurable condition that causes widespread pain and extraordinary fatigue.  The disclosure of the diagnosis doesn’t end the litany of judgment and well intentioned but poorly considered comments that somehow imply that those with the condition are exaggerating malingerers.  They are not.

The problem with the posts about how “real” fibromyalgia is, is that they fuel speculation among the poory informed that it is not real, otherwise why go on about it?  Yes, we need to build awareness, but let’s allow the scientific evidence to speak for us.  It’s more likely to be believed by the dinosaurs who perpetuate the notion fibro is a psychosomatic disorder.  We don’t need to beg for understanding.  The truth is on our side.